Electrophysiology catheter system

Abstract

Described herein are devices and methods for treating tissue, comprising a catheter with a plurality of access sites and a plurality of sensors associated with the access sites. The catheter may be positioned along a tissue surface and the sensors may be used to identify a target site along the tissue surface using the plurality of sensors. Analysis of the tissue surface by the sensors is performed without requiring repositioning of the catheter. In some examples, the access sites of the catheter are side openings along a length of the catheter and the plurality of sensors are electrodes configured to measure electrophysiology parameters. In these examples, the catheter may comprise an internal lumen which permits a treatment device, such as an ablation catheter, to be slidably positioned at the desired target site without requiring displacement of the catheter. In other examples, the catheter may comprise a plurality of fixed ablation elements associated with the plurality of access sites.

1 . A device for assessing tissue, comprising an elongate outer body, a plurality of longitudinally arranged sensor structures associated with a plurality of longitudinally arranged access regions of the elongate body, and wherein each sensor structure comprises a lead wire with a distal end coupled to a sensor structure and a proximal end located about a proximal portion of the elongate outer body. 
     
     
         2 . The device of  claim 1 , wherein the sensor structure is an electrode structure. 
     
     
         3 . The device of  claim 1 , wherein the plurality of longitudinally arranged access regions comprises a plurality of longitudinally arranged access openings. 
     
     
         4 . The device of  claim 1 , further comprising a movable inner member within the elongate outer body and configured to be selectively positioned at each access region. 
     
     
         5 . The device of  claim 4 , wherein the movable inner member comprises an ablation assembly. 
     
     
         6 . The device of  claim 4 , wherein the movable inner member comprises a tissue injection assembly. 
     
     
         7 . The device of  claim 4 , wherein the movable inner member comprises a sensor assembly. 
     
     
         8 . The device of  claim 4 , wherein the movable inner member comprises an anchor delivery assembly. 
     
     
         9 . A method for evaluating a patient for a cardiac abnormality, comprising:
 positioning a catheter along a portion of an cardiac surface, wherein the catheter comprises a plurality of longitudinally arranged electrodes and at least two side openings;   assessing the physiological activity at a plurality of cardiac sites along the portion of the cardic surface without requiring repositioning of the catheter;   selecting an target site based upon the physiological activity of the plurality of cardiac sites;   positioning an active element at the target site; and   acting on the target site using the active element and at least one side opening of the catheter.   
     
     
         10 . The method of  claim 9 , wherein the cardiac surface is an endocardial surface and wherein the plurality of cardiac sites are endocardial sites. 
     
     
         11 . The method of  claim 9 , acting on the target site comprises ablating the target site using an active element that comprises an ablation element. 
     
     
         12 . The method of  claim 9 , wherein assessing the physiological activity at the plurality of cardiac sites comprises assessing the physiological activity of at least two cardiac sites simultaneously. 
     
     
         13 . The method of  claim 10 , wherein the portion of the endocardial surface comprises annular tissue associated with the mitral valve. 
     
     
         14 . The method of  claim 13 , wherein the annular tissue is subvalvular annular tissue. 
     
     
         15 . The method of  claim 11 , further comprising contacting the ablation element to the target site through a side opening. 
     
     
         16 . The method of  claim 15 , wherein the ablation element is selected from a group consisting of radiofrequency ablation element, a cryoablation element and a high intensity focused ultrasound element. 
     
     
         17 . The method of  claim 9 , wherein positioning the active element at the target site is performed without moving the catheter. 
     
     
         18 . A tissue remodeling system for use in a patient, comprising:
 an anchor delivery catheter comprising a through lumen and a first delivery aperture configured to releasably retain a biased anchor slidably coupled to a tether;   a tracking system configured for insertion into a body of a patient and comprising at least one electrode configured to acquire electrical information.   
     
     
         19 . The tissue remodeling system as in  claim 18 , wherein the electrical information is tissue impedance information. 
     
     
         20 . The tissue remodeling system as in  claim 18 , wherein the electrical information is membrane voltage information. 
     
     
         21 . The tissue remodeling system as in  claim 18 , wherein at least a portion of the tracking system is embedded in a wall of the anchor delivery catheter. 
     
     
         22 . The tissue remodeling system as in  claim 21 , wherein at least two surface electrodes are located about the first delivery aperture. 
     
     
         23 . The tissue remodeling system as in  claim 18 , further comprising a tunnel catheter, wherein the tunnel catheter comprises a catheter lumen with at least one anchor aperture. 
     
     
         24 . The tissue remodeling system as in  claim 23 , wherein at least a portion of the tracking system is embedded in a wall of the tunnel catheter. 
     
     
         25 . The tissue remodeling system as in  claim 20 , wherein the tracking system further comprises an electrophysiology signal processor configured to receive a signal from the at least one electrode. 
     
     
         26 . The tissue remodeling system as in  claim 24 , wherein the tunnel catheter comprises at least seven longitudinally spaced anchor apertures. 
     
     
         27 . The tissue remodeling system as in  claim 26 , wherein the tracking system comprises at least eight electrodes. 
     
     
         28 . The tissue remodeling system as in  claim 27 , wherein at least one electrode is located between each adjacent pair of longitudinally spaced anchor apertures of the tunnel catheter. 
     
     
         29 . The tissue remodeling system as in  claim 23 , wherein the surface electrodes of the tracking system are at least double in number with respect to the number of anchor apertures of the tunnel catheter. 
     
     
         30 . The tissue remodeling system as in  claim 18 , wherein the tracking system further comprises a catheter-embedded antenna assembly. 
     
     
         31 . The tissue remodeling system as in  claim 23 , further comprising a magnetic navigation element. 
     
     
         32 . The tissue remodeling system as in  claim 31 , wherein the magnetic navigation element is located at a distal portion of the delivery catheter. 
     
     
         33 . The tissue remodeling system as in  claim 31 , further comprising a guidewire, wherein the magnetic navigation element is located at a distal portion of the guidewire. 
     
     
         34 . The tissue remodeling system as in  claim 18 , further comprising an energy-delivery assembly. 
     
     
         35 . The tissue remodeling system as in  claim 34 , wherein the energy-delivery assembly is integral with the anchor delivery catheter. 
     
     
         36 . A method for securing an anchor to a body structure, comprising:
 providing a first anchor;   positioning the first anchor at a first anchor deployment site;   assessing a physiologic property of the first anchor deployment site; and   deploying the first anchor at the first anchor deployment site.   
     
     
         37 . The method for securing an anchor as in  claim 36 , further comprising changing the first anchor deployment site based upon the physiologic property. 
     
     
         38 . The method for securing an anchor as in  claim 37 , further comprising reassessing the physiologic property of the first anchor deployment site after changing the first anchor deployment site. 
     
     
         39 . The method for securing an anchor as in  claim 36 , wherein the physiologic property is an electrical property. 
     
     
         40 . The method for securing an anchor as in  claim 39 , wherein the electrical property is a membrane voltage or a tissue impedance. 
     
     
         41 . The method for securing an anchor as in  claim 36 , further comprising:
 positioning a second anchor at a second anchor deployment site;   assessing a physiologic property of the second anchor deployment site; and   deploying the second anchor at the second anchor site.   
     
     
         42 . The method for securing an anchor as in  claim 41 , further comprising retaining a tether coupled to the first anchor and the second anchor after deploying the first anchor and second anchor. 
     
     
         43 . The method for securing an anchor as in  claim 36 , further comprising changing a tissue structure at the first anchor deployment site. 
     
     
         44 . The method for securing an anchor as in  claim 43 , further comprising:
 deploying the first anchor through a first opening of the catheter;   deploying the second anchor through a second opening of the catheter;   retaining the first coupling portion of the implant in the catheter, wherein the first coupling portion is located between two anchors secured to the body structure; and   releasing the first coupling portion of the implant from the catheter after securing the first anchor and the second anchor to body tissue.   
     
     
         45 . The method for securing an anchor as in  claim 36 , wherein releasing the first coupling portion of the implant from the catheter comprises disengaging a wall section of the catheter. 
     
     
         46 . The method for securing an anchor as in  claim 36 , further comprising positioning the catheter in a subvalvular space of a ventricle. 
     
     
         47 . The method for securing an anchor as in  claim 43 , wherein changing the tissue structure at the first anchor deployment site comprises causing protein denaturation at the first anchor deployment site. 
     
     
         48 . The method for securing an anchor as in  claim 43 , wherein changing the tissue structure at the first anchor deployment site comprises causing at least some tissue ablation at the first anchor deployment site. 
     
     
         49 . The method for securing an anchor as in  claim 41 , further comprising cinching the first anchor and the second anchor closer together. 
     
     
         50 . The method for securing an anchor as in  claim 49 , further comprising reassessing the physiologic properties of the first and second anchor deployment sites after cinching. 
     
     
         51 . The method for securing an anchor as in  claim 50 , further comprising adjusting the cinching of the first anchor and the second anchor based upon reassessing the physiologic properties of the first and second anchor deployment sites. 
     
     
         52 . The method for securing an anchor as in  claim 50 , further comprising securing the cinched first anchor and second anchor. 
     
     
         53 . The method for securing an anchor as in  claim 52 , wherein securing the cinched first anchor and second anchor occurs after reassessing the physiologic properties of the first and second anchor deployment sites. 
     
     
         54 . A method for assessing body tissue, comprising:
 providing an image of a body structure constructed from localized body structure information;   positioning an anchor delivery system about the body structure, wherein the anchor delivery system comprises a sensor and an anchor coupled to a tether;   taking a localized information reading using the sensor of the anchor delivery system; and   comparing the localized information reading to the image of the body structure;   deploying the anchor at a target site of the body structure.   
     
     
         55 . The method as in  claim 54 , further comprising:
 repositioning the anchor delivery system based upon comparing the localized information reading to the image of the body structure.   
     
     
         56 . The method as in  claim 54 , wherein the image of the body structure is a three-dimensional image. 
     
     
         57 . The method as in  claim 54 , wherein the localized tissue information is electrical-based tissue information. 
     
     
         58 . The method as in  claim 54 , wherein the localized tissue information comprises membrane potential data or impedance data. 
     
     
         59 . The method as in  claim 54 , wherein the localized tissue information comprises tissue compliance data. 
     
     
         60 . The method as in  claim 59 , wherein the tissue compliance data was generated using a catheter-based pressure sensor. 
     
     
         61 . The method as in  claim 54 , further comprising determining an anchor delivery system location. 
     
     
         62 . A method for treating body tissue, comprising:
 accessing a plurality of cardiac target sites in a patient using a tubular body;   deploying a plurality of biased anchors at the plurality of cardiac target sites using the tubular body, wherein the plurality of biased anchors are coupled to a tether member;   delivering energy to at least one of the plurality of cardiac target sites using the tubular body in an amount sufficient to at least denature some protein at the at least one of the plurality of cardiac target sites; and   withdrawing the tubular body after deploying the plurality of biased anchors and after delivering energy to at least one of the plurality of cardiac target sites.